• Barnaby King

Pain Is Not What You Think

Right now the way that most people think about pain and address it is not only unhelpful, it is actually plain wrong. AND, it is making the problem worse.

Despite a great deal of research, many health providers continue to push these old ideas. Why? This article from The Guardian suggests Doctors know this but they give in to patients’ (that’s us!) demands for a quick and simple ‘get out of pain’ card. So they prescribe drugs, order an MRI, or even recommend surgery.

Our desire to get out of pain as quickly as possible is understandable, since that is what pain is biologically meant to make us want to do. But, as I will explain, reacting to pain from the immediate experience of it doesn’t help to address the deeper problem that is causing the pain, and so it likely resurfaces, worsens, or at the very least doesn’t stop.

So what I want to offer you is the bigger picture of pain and what it is. When you have that bigger picture it’s going to help you address your own pain with a higher degree of calm and clarity about what is actually going to be effective or not.

The first idea thing to realise is that pain is not inherently a bad thing. Pain is not your enemy. In fact pain is neutral. It is a thing that occurs. The thoughts and feelings that we have about that pain are additional meanings that we put on top of the neutral presence of pain. This is a stretch for many people, especially those in pain. But it is backed up by science, as I will explain.

This realisation, supported by the latest science, is crucial because understanding the nature of pain allows you to eliminate the actions, choices and behaviors that are a distraction from addressing the real cause.

So what is pain?

In fact we all know the answer to this. Think about when you touch a hot pan or get too close to a fire. We all recognise that pain is there as a warning signal to protect you. It serves the function of calling your attention, really quick. Pain is not there to make you suffer. Pain is there in support of you being able to survive and thrive.

Millions of years of genetic refinement have led to a seemingly failsafe mechanism designed to create a response which leads to a greater degree of safety and a chance of survival. Your nervous system and your brain are making a calculation that will lead you to take appropriate action: is this dangerous or not? Is this going to threaten my survival or not? And it creates pain signals accordingly.

Lorimer Mosely, the eminent Australian pain researcher, describes pain as an opinion born in your consciousness. He has carried out hundreds of tests and studies to arrive at this conclusion, but the best illustration of it is perhaps his own story (you see him very entertainingly tell the full version HERE), in which he feels a scratch on a his leg while hiking in the Australian bush, which he assumed was a twig scraping him. Later Mosely nearly dies because in actual fact he had been bitten by an extremely dangerous snake. Some time later he is hiking once again and feels a sudden excruciating pain in his leg which causes him to scream and writhe on the ground, convinced he was going to die, only to discover he had in fact been scratched by a twig.

This strange (but true) story perfectly demonstrates the point that the nervous system in effect ‘decides’ when to create the sensation of pain in our conscious minds, based not only on actual physical evidence of damage or imminent damage, but on many circumstantial factors and past experiences.

The obvious point we can draw from this is also a cataclysmically radical one in society even today: pain is not evidence of a physical problem, but an impulse created in the nervous system, in the consciousness, and it is highly subjective and highly responsive to psychological and environmental factors.

This shocked me to the core when I found it out, and I personally had to do a lot of research before I could wrap my head about this idea that was so contradictory to what is practiced and what I was raised to believe and what modern society and common knowledge teaches us.

Yet a lot of science points in this same direction. In his book The Ultimate Placebo, Ian Harris documents a number of research studies that all came to the conclusion that most major joint surgeries in the world are irrelevant. They don’t seem to have any better effect than a placebo surgery. Harris, an orthopedic surgeon specializing in hip surgery, casts doubt on the way modern medicine treats joint pain because if it can be resolved through a placebo (i.e. no actual surgery) we know that pain must be, as Mosely says, ‘an opinion’ of the nervous system based on an interpretation of evidence, not a physical or structural problem.

But how does this affect the way we address pain ourselves? If going down the standard medical route is to be ignorant of the true nature of pain, what other options do we have?

Thinking of pain as structural, a problem in your tissue, hugely limits your capacity to have an impact. If you think it’s structural you might think it’s due to ageing, for example, and you can’t stop ageing. You might think it’s due to your genetic blueprint, and there’s nothing you can do to change your genetics. You might think it’s due to an old injury, or lack of cartilage or some other physical imperfection in the joint itself and there’s very limited chance that you can ever change that. Thinking of it in this way hugely limits your independence and agency in your situation.

On the other hand, if we think about pain as a signal in the nervous system or an ‘opinion’, not only does the science point in that direction, but it also opens the door to so much more possibility, so much more freedom and independence. The clear implication is that your nervous system is plastic; it is malleable; just in the same way that it can learn pain, it can unlearn pain; in the same way that you learn a habit, you can learn a new habit that replaces the old habit. How much more empowering is it to think that moving beyond pain is a matter of treating our nervous system and ‘unlearning’ pain, as opposed to fixing a broken part of our body?

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